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“We shouldn’t assume that those providers are going to do well because now they have a paying population,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “The people living in those communities—unless you have rent stabilization—they get forced out, and many times their providers get forced out.”
A changing healthcare landscape
Gentrification has appeared to neither stop nor slow down the financial challenges many urban safety-net providers face.
Urban safety-net hospitals typically serve a larger share of patients who are either covered by Medicaid or are uninsured. Community hospitals also traditionally receive a smaller share of patients with higher-paying commercial insurance compared with larger health systems. Such factors often result in many safety-net providers operating on slim margins.
While such challenges have forced some urban hospitals to close over the past decade and put many more at risk, an array of outpatient care options, including urgent care centers, specialty practices, ambulatory surgical centers and retail health clinics, have opened in many of those same gentrified communities.
“If their paying patients with the better-reimbursed insurance plans leave them for these other entities, either another hospital farther away or for these outpatient opportunities, then they lose the patients that give them the margins,” Benjamin said. “In some ways it could precipitate an already fragile financial situation at that institution to spiral down.”
In Brooklyn, New York, the increase of affluent, white residents into some of its working-class neighborhoods over the past 20 years has coincided with the rapid decline of Black and Latino populations in those communities.
The Williamsburg neighborhood in northern Brooklyn has been one of the fastest-gentrifying areas for years. The average cost of rent went from $1,050 in 2006 to $2,060 in 2019, according to data from New York University’s Furman Center. By contrast, median rent within Brooklyn overall rose from $1,150 to $1,510 during that same period.
“Gentrification creates housing insecurity in poor communities that leads to immense challenges to delivering good healthcare,” said Robert Hayes, president and CEO of Community Healthcare Network, a chain of 13 federally qualified health centers throughout Brooklyn, Manhattan, Queens and the Bronx.
While Hayes acknowledged the gentrification that has occurred in Williamsburg has had a minimal impact on patient volume at CHN’s clinic in that neighborhood, he said the vast majority of those patients remain among the area’s most vulnerable. Approximately 65% of its patients are covered by Medicaid and 10% by Medicare, with many of the rest being uninsured. He said other providers that have opened sites within the community in recent years are primarily seeking patients covered by Medicare or who are privately insured.
The result has created a niche patient market for CHN, at least until more of the community’s low- and moderate-income residents are displaced.
“The profit-making health businesses don’t really want our patients,” Hayes said.
While patient volume remains largely unaffected, the influx of newer outpatient sites into the area has increased competition for healthcare professionals. Hayes said the higher demand for workers has made it more difficult to hire and retain clinical staff when other providers can offer more competitive salaries.
“We’ve always had to struggle with competition for doctors and other providers with the hospital systems,” Hayes said. “Some of these groups that come in with a load of private equity pose a similar threat to our workforce.”
Addressing concerns
Ten years ago, Humboldt Park Health, known at the time as Norwegian American Hospital, was on the verge of closing its doors when the provider faced bankruptcy. Agrawal said it was then the organization put in place a transformation plan that heavily focused on improving quality measures to gain the community’s trust in the organization’s care delivery services.
That focus has resulted in Humboldt Park Health lowering its infection rates and reducing unsafe practices among clinical staff.
Agrawal felt the organization could leverage the success of its quality improvements to attract more of the community’s newer residents to access their services. In recent years the organization has also sought to use its digital front door as a means of attracting more tech-savvy residents. Agrawal said the hospital’s self-scheduling options on its website makes it more efficient for residents to set up appointments. She said patients discover they can get diagnostic services like MRIs in a couple of days at the hospital compared with waiting a few weeks at other providers.
But it has been the hospital’s focus on establishing partnerships with other community healthcare providers that has been one of its primary approaches to attracting more community patients.
The hospital currently has partnerships with two local community health centers and frequently reaches out to new neighborhood physician practices and clinics to find opportunities to work together, Agrawal said. Such outreach has led Humboldt Park Health to form informal affiliations with several community-based physicians.
“It’s for people who like to see this as a high-quality option for the care of their patients,” Agrawal said of the partnerships.
Community collaboration is also the focus of the approach taken by University of Houston College of Medicine as providers there seek to help mitigate effects of the early stages of gentrification going on within the city’s Third Ward.
Investment within the historically Black community began roughly 10 years ago, yet many of the changes associated with gentrification have yet to be fully realized, said Dr. Brian Reed, chair of the clinical sciences department at the medical school.
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